Healthcare Provider Details

I. General information

NPI: 1013604644
Provider Name (Legal Business Name): SMILE DOCTORS OF COLORADO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 YALE PL
CANON CITY CO
81212-4611
US

IV. Provider business mailing address

5400 LBJ FWY STE 800
DALLAS TX
75240-1058
US

V. Phone/Fax

Practice location:
  • Phone: 719-417-5625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SCOTT V. LAW
Title or Position: PRESIDENT
Credential: DMD
Phone: 719-569-5715